The Pill: A Brief History of Birth Control in the United States

Feminist Margaret Sanger was arraigned in the Federal Courthouse on January 18, 1916 for distributing her journal “The Woman Rebel” by mail in which she advocated for birth control use. Photos Courtesy: Bettmann/Getty Images

Across many industries, colloquial terms for products and inventions have a real staying power. You’ve probably heard someone refer to a tissue by saying “Kleenex,” for example. Similarly, folks use the brand name Band-Aid as a stand-in for referring to bandages. 

Another common colloquialism? Calling birth control pills simply “the pill.” Taken orally, these hormonal contraceptives are synonymous with the term — even though many medications come in capsule (or pill) form. Still, if you say “the pill,” people across generations will immediately know that you’re referring to birth control. 

Today, a person’s contraceptive choices extend beyond the pill. But the history of the ubiquitous phrase — and the medication itself — figure so prominently into the history of reproductive rights, health care, sexual health, and bodily autonomy. With this in mind, let’s delve into the history of birth control in the United States, and how this history is still deeply tied into the fight for equal rights today. 

What Is “The Pill”? 

By definition, birth control is any action or medication that help regulate when (and if) cisgender women, intersex people, and individuals assigned female at birth will become pregnant. Although the pill might be one of the more common forms of contraceptive medication, intrauterine devices, implants, condoms, diaphragms, and methods of tracking ovulation are all forms of birth control. 
Photo Courtesy: BSIP/Universal Images Group/Getty Images

Of course, the pill remains one of the more accessible, safe and effective methods of birth control. Not to mention, the pill left an indelible mark on American society when the revolutionary medication was first introduced. Prior to the pill, birth control methods were cumbersome and often unreliable. The pill, on the other hand, was discreet, easy to use, and less intrusive. According to the AMA Journal of Ethics, the Food & Drug Administration (FDA) approved the first oral contraceptive in 1960, and, within two years, 1.2 million American women were using the pill. 

So, what’s in this revolutionary medication? Essentially, the pill is an ingestible form of progestin and estrogen. These hormones mimic pregnancy and trick the body into initiating all of the processes that make it more difficult to get pregnant. For example, more mucus forms on the walls of the cervix, which, in turn, prevents sperm from traveling up the birth canal, and the walls of the uterus become thinner. Most significantly, someone taking the pill will stop ovulating, so there won’t be any eggs to fertilize. Needless to say, the pill helped make pregnancy more of a choice than an inevitability, allowing people to have a much larger degree of control over their reproductive health, bodies, sexual health, and futures. 

History of Birth Control in the United States

In 1916, Margaret Sanger opened one of the earliest-known birth control clinics in America. Due to the Comstock Act, which deemed birth control “obscene,” the clinic could not write, publish, or distribute any information about birth control. Since virtually all methods of birth control were illegal at the time, Sanger and her colleagues were also unable to perform or prescribe any methods of birth control. Rather, the clinic served as a source of information, allowing people — primarily women — to learn of safe and effectives means of taking control of their reproductive health. 

Announced by Sanger, a birth control clinic was opened in secret on First Avenue in New York City. Photo Courtesy: Bettmann/Getty Images

Decades after opening her first clinic, Sanger met an endocrinologist, Gregory Pincus, who believed in her idea to develop a birth control pill. Testing the pill was perhaps even harder than creating the pill; there was plenty of legal red tape — not to mention an ingrained, societal (and misogynistic) fear surrounding the reproductive system and the sexual health of women. After receiving a generous donation from Katherine McCormick, a wealthy biologist and activist, Pincus and Sanger ran a larger clinical trial in Puerto Rico, where laws weren’t as restrictive. 

Eventually, the FDA approved the pill in 1957, but it was only to be used in the treatment of menstrual disorders experienced by married women. In 1960, the FDA fully approved birth control as a contraceptive. Despite the expansion of the FDA approval, there were still millions of people who did not have access to birth control. In 1965, the Supreme Court ruled that states were not allowed to ban birth control pills, but it wasn’t until 1972 that the Supreme Court ruled that unmarried women had the right to take birth control pills. In many ways, referring to the medication as “the pill” was born out of a necessity — to be discreet and avoid any stigma. 

In the early decades of the widespread use of oral contraceptives, doctors and patients who were reporting serious side effects, like blood clots and strokes, were ignored, and this led to a campaign against birth control from the medical community. There was also a concern surrounding where birth control pills were being distributed. “Sanger’s stated mission was to empower women to make their own reproductive choices,” Time reports. “She did focus her efforts on minority communities, because that was where, due to poverty and limited access to health care, women were especially vulnerable to the effects of unplanned pregnancy.” However, these efforts, and Sanger’s legacy, have been tainted by her well-documented comments in support of eugenics, a now-discredited, discriminatory movement mired in white supremacist beliefs. 

How Birth Control Relates to Equality

Using the pill is far less controversial today than it was in decades past, but birth control — and other facets of reproductive freedom — continues to be met with opposition in the U.S. For example, many conservative Christian sects object to birth control, believing that it goes against God’s will. Politically, this has long been a stance that right-wing politicians and supporters take on as well, often taking aim against Planned Parenthood, reproductive rights, access to abortion and contraception, and more. 

Why? Because birth control relates to sexual health, these groups of people act as though the pill is a matter of morality. That is, their religious or political beliefs can actually interfere with health care. Even now, religious and non-profit employers can offer health insurance plans that exclude coverage of birth control if done so because of a religious or moral belief. 

On the other hand, the Affordable Care Act states that all health insurance plans offered in the Health Insurance Marketplace must cover FDA-approved methods of birth control. That’s just one step toward providing access to reproductive health care. For example, birth control is one of the safest medications on the market today, but it can’t be bought over the counter (OTC); many groups, such as Free the Pill, are fighting to make OTC birth control a reality in the U.S.

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Planned Parenthood of St. Louis on May 29, 2020 — just after a state judge ruled against an attempt by the Gov. Mike Parson administration to shut down Missouri’s lone abortion clinic. Photo Courtesy: Robert Cohen/Getty Images

Of course, others are hoping to make the pill free of charge to further support gender equity and equality efforts — in addition to making the pill more accessible to all people, regardless of socioeconomic class, race or gender. “Despite significant strides in women’s reproductive health, disparities in access and outcomes remain, especially for racial–ethnic minorities in the United States,” a 2020 study reports. “Data suggest that the disproportionate risk for women of color for reproductive health access and outcomes expand beyond individual-level risks and include social and structural factors, such as fewer neighborhood health services, less insurance coverage, decreased access to educational and economic attainment, and even practitioner-level factors such as racial bias and stereotyping.” Needless to say, the pill being free of charge — and more easily attainable — could go a long way in remedying these racial disparities. 

People who support access to birth control — and fight for reproductive justice — understand that without birth control women and other people at risk for pregnancy face severe disadvantages across many facets of life. For one, an unplanned or unwanted pregnancy can impact one’s ability to work or build a career. In other instances, someone who may become pregnant might not be physically, emotionally or mentally healthy enough, or have access to the resources, to have and raise a child safely. In fact, over 800 people die during pregnancy ever day; millions are saved from this fate due to birth control access. 

Access to contraception allows people to plan their lives by affording them more opportunity; that is, instead of being handed a decision, people can choose. The pill may be tiny, but, undoubtedly, it gives millions of people a huge boost of support by allowing them to plan for parenthood if they want to embark on that path. 

Photo Courtesy: Bill Tompkins/Michael Ochs Archives/Getty Images

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